Progressive liver injury and increased mortality risk in COVID-19 patients: A retrospective cohort study in China

Zhang, Shui-Sheng; Li, Dong; Wang, Gao-Ming; Tian, Yuan; Xiaofang, YE; Zhao, Yue; Liu, Zhengyin; Zhai, Jian; Zhao, Zhiling; Wang, Junhong; Zhang, Huimin; Li, Xiaolong; Wu, Changxin; Yang, Caiting; Yang, Lijuan; Du, Haixia; Wang, Hui; Ge, Qi; Xiu, Dianrong; Shen, Ning

doi:10.3748/wjg.v27.i9.835

Cited by 15 publications

(22 citation statements)

References 20 publications

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“…In addition, our findings indicated that an age > 60 years, diabetes mellitus and increased serum ferritin levels were independent strong predictors of mortality among patients with COVID-19 presenting liver injury. These observations are consistent with recent studies[ 10 ].…”

Section: Discussionsupporting

confidence: 94%

Hepatocellular injury and the mortality risk among patients with COVID-19: A retrospective cohort study

Madian

Eliwa

Abdalla

et al. 2021

WJH

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BACKGROUND Clearly, infection with severe acute respiratory syndrome coronavirus 2 is not limited to the lung but also affects other organs. We need predictive models to determine patients’ prognoses and to improve health care resource allocation during the coronavirus disease 2019 (COVID-19) pandemic. While treating COVID-19, we observed differential outcome prediction weights for markers of hepatocellular injury among hospitalized patients. AIM To investigate the association between hepatocellular injury and all-cause in-hospital mortality among patients with COVID-19. METHODS This multicentre study employed a retrospective cohort design. All adult patients admitted to Al-Azhar University Hospital, Assiut, Egypt and Abo Teeg General Hospital, Assiut, Egypt with confirmed COVID-19 from June 1, 2020, to July 30, 2020 were eligible. We categorized our cohort into three groups of (1) patients with COVID-19 presenting normal aminotransferase levels; (2) patients with COVID-19 presenting one-fold higher aminotransferase levels; and (3) patients with COVID-19 presenting two-fold higher aminotransferase levels. We analysed the association between elevated aminotransferase levels and all-cause in-hospital mortality. The survival analysis was performed using the Kaplan–Meier method and tested by log-rank analysis. RESULTS In total, 376 of 419 patients met the inclusion criteria, while 29 (8%) patients in our cohort died during the hospital stay. The median age was 40 years (range: 28-56 years), and 51% were males ( n = 194). At admission, 54% of the study cohort had liver injury. The pattern of liver injury was hepatocellular injury with an aspartate aminotransferase (AST) predominance. Admission AST levels were independently associated with all-cause in-hospital mortality in the logistic regression analysis. A one-fold increase in serum AST levels among patients with COVID-19 led to an eleven-fold increase in in-hospital mortality ( P < 0.001). Admission AST levels correlated with C-reactive protein ( r = 0.2; P < 0.003) and serum ferritin ( r = 0.2; P < 0.0002) levels. Admission alanine aminotransferase levels correlated with serum ferritin levels ( r = 0.1; P < 0.04). Serum total bilirubin levels were independently associated with in-hospital mortality in the binary logistic regression analysis after adjusting for age and sex but lost its statistical significance in the fully adjusted model. Serum ferritin levels were significantly associated with in-hospital mortality ( P < 0.01). The probability of survival was significantly different between the AST groups and showed the following order: a two-fold increase in AST levels > a one-fold increase in in AST levels > normal AST l...

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Section: Discussionsupporting

confidence: 94%

Hepatocellular injury and the mortality risk among patients with COVID-19: A retrospective cohort study

Madian

Eliwa

Abdalla

et al. 2021

WJH

View full text Add to dashboard Cite

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“…All published literature which analyzed liver biochemical parameters in COVID-19 patients was examined through databases and shown in Table 1 [ 5 , 6 , 11 , [15] , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] ]. Based on previous studies, liver biochemical parameters abnormalities were defined as the elevation of the following liver enzymes in serum: ALT > 40 U / L, AST > 40 U / L, and total bilirubin> 1.20 mg/d l. As in a previous study, we defined ALT and/or AST over three times upper limits of normal (ULN), and/or total bilirubin over two times ULN as liver injury [7] .…”

Section: Methodsmentioning

confidence: 99%

Liver function as a predictor of mortality in COVID-19: A retrospective study

Salık

Uzundere

Bıçak

et al. 2021

Annals of Hepatology

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Introduction and Objectives In many studies, varying degrees of liver damage have been reported in more than half of the COVID-19 patients. The aim of this study is to determine the effect of liver biochemical parameters abnormality on mortality in critical COVID-19 patients who have been followed in the ICU since the beginning of the pandemic process. Materials and Methods In this study 533 critical patients who admitted to the ICU due to COVID-19 were included. The patients were divided into three groups according to their ALT, AST, and total bilirubin levels at their admission to the ICU. Group 1 was formed of patients with normal liver biochemical parameters values; Group 2 was formed of patients with liver biochemical parameters abnormality; Group 3 was formed of patients with liver injury. Results 353 (66.2%) of all patients died. Neutrophil, aPTT, CRP, LDH, CK, ALT, AST, bilirubin, procalcitonin and ferritin values in Group 2 and Group 3 were found to be statistically significantly higher than Group 1. It was detected that the days of stay in ICU of the patients in Group 1 was statistically significantly longer than others group. It was found that the patients in Groups 2 and 3 had higher total, 7-day, and 28-day mortality rates than expected. Conclusions The study showed that liver disfunction was associated with higher mortality and shorter ICU occupation time.

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“…Severe ALI (>20 upper limit of normal transaminase levels) is uncommon occurring in <0.1% of infected patients 7. ALI reflected by increased transaminases and bilirubin was related to disease severity and poor outcome of COVID-19 8. Increases in gamma glutamyl transferase (γGT) and alkaline phosphatase (AP) are less frequently observed and found more in the later course of disease, whereas moderate increases in AST, ALT and bilirubin are a very common feature in COVID-19 disease 9.…”

Section: Covid-19: Liver Manifestations and Pathophysiological Aspectsmentioning

confidence: 99%

COVID-19 and liver disease

Dufour

Marjot

Becchetti

et al. 2022

Gut

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Knowledge on SARS-CoV-2 infection and its resultant COVID-19 in liver diseases has rapidly increased during the pandemic. Hereby, we review COVID-19 liver manifestations and pathophysiological aspects related to SARS-CoV-2 infection in patients without liver disease as well as the impact of COVID-19 in patients with chronic liver disease (CLD), particularly cirrhosis and liver transplantation (LT). SARS-CoV-2 infection has been associated with overt proinflammatory cytokine profile, which probably contributes substantially to the observed early and late liver abnormalities. CLD, particularly decompensated cirrhosis, should be regarded as a risk factor for severe COVID-19 and death. LT was impacted during the pandemic, mainly due to concerns regarding donation and infection in recipients. However, LT did not represent a risk factor per se of worse outcome. Even though scarce, data regarding COVID-19 specific therapy in special populations such as LT recipients seem promising. COVID-19 vaccine-induced immunity seems impaired in CLD and LT recipients, advocating for a revised schedule of vaccine administration in this population.

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Progressive liver injury and increased mortality risk in COVID-19 patients: A retrospective cohort study in China

Cited by 15 publications

References 20 publications

Hepatocellular injury and the mortality risk among patients with COVID-19: A retrospective cohort study

Hepatocellular injury and the mortality risk among patients with COVID-19: A retrospective cohort study

Liver function as a predictor of mortality in COVID-19: A retrospective study

COVID-19 and liver disease

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